{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T09:05:22Z","timestamp":1789290322973,"version":"build-2803163510"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"8","content-domain":{"domain":["jocr.co.in"],"crossmark-restriction":true},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction: Myxofibrosarcoma (MFS) is among the most common soft-tissue sarcomas of the extremities in elderly patients; however, presentation as a pathological fracture is exceptionally rare. The tumor\u2019s fluid-rich myxoid matrix produces magnetic resonance imaging signal characteristics that closely mimic benign vascular lesions, creating a significant diagnostic challenge when encountered outside a tertiary setting. We report a case of low-grade myxofibrosarcoma presenting as a pathological pilon fracture.\n\nCase Report: A 60-year-old male presented with a 2-week history of ankle pain following an inversion injury that was refractory to conservative management, accompanied by a 6 kg weight loss over 4 months. Examination revealed cachexia, diffuse lower-limb swelling, and skin induration. Plain radiographs demonstrated a sagittally angulated pathological pilon fracture with diffuse moth-eaten osteolysis of the tibia and fibula. Magnetic resonance imaging revealed a large 35 \u00d7 6.5 \u00d7 6.1 cm inter- and intramuscular lesion initially reported as cavernous lymphangioma. Open core needle biopsy established the diagnosis of low-grade myxofibrosarcoma. The patient declined the recommended high transfemoral amputation; 3 weeks later, cutaneous fungation developed. Final histopathology of the amputation specimen confirmed progression to high-grade myxofibrosarcoma (350 mm) with multifocal bone invasion and clear resection margins. At 48 months postoperatively, the patient remains disease-free.\n\nConclusion: MFS may present as a pathological fracture with imaging features indistinguishable from benign pathology. Mandatory pre-operative tissue biopsy and prompt referral to a specialist sarcoma center are essential to prevent diagnostic delay, unplanned excision, and the associated risk of tumor progression.\n\nKeywords: Myxofibrosarcoma, pathological pilon fracture, soft-tissue sarcoma, cavernous lymphangioma, limb amputation, bone invasion, magnetic resonance imaging misdiagnosis.<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i08.7882","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T09:53:08Z","timestamp":1786182788000},"page":"312-317","update-policy":"https:\/\/doi.org\/10.13107\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-Grade Myxofibrosarcoma of the Leg Presenting as a Pathological Pilon Fracture: A Case Report"],"prefix":"10.13107","volume":"16","author":[{"given":"Amit","family":"Bhardwaj","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Sengkang General Hospital, Sengkang, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraj","family":"Sajeev","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Sengkang General Hospital, Sengkang, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T08:45:27Z","timestamp":1789289127000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/08\/low-grade-myxofibrosarcoma-of-the-leg-presenting-as-a-pathological-pilon-fracture-a-case-report\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i08.7882","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"Research Article","name":"content_type","label":"Content Type"},{"value":"Yes","name":"crosschecked","label":"CrossChecked"},{"value":"Yes","name":"peer_reviewed","label":"Peer Reviewed"},{"value":"10.13107\/jocr.2026.v16.i08.7882","name":"published","label":"Published"},{"value":"Creative Commons Attribution","name":"license","label":"License","explanation":{"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},"group":{"name":"rights","label":"Rights"}}]}}